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Module 3

Practice of Pharmacy

Clinical Pharmacy, Hospital Pharmacy, Pharmaceutical Calculations

Kathreen Mae D. Cascabel


BSPharmacy
Clinical Pharmacy
 A practice in which the pharmacist utilizes his professional judgment in the application of pharmaceutical sciences
to foster the safe and appropriate use of drugs, in or by patients, while working with members of the health care
team (Francke 1969)

 Health science specialty whose responsibility is to assure the safe and appropriate use of drugs in patients through
the application of specialized knowledge and functions in health care
Pharmaceutical Care
o The responsible provision of drug therapy for the purpose of achieving definite outcomes that improves a
patient’s QOL (Helper and Strand 1990)
o A patient-centered practice in which the practitioner assumes responsibility for a patient’s drug related needs and
is held accountable for this commitment (Cipolle 1998)
o Identify, resolve, prevent potential and actual drug related problems
o Knowledge and skills required: Diseases, drug therapy, non-drug therapy, lab and diagnostic testing

Outcomes
- Cure of disease
- Elimination or Reduction of symptoms
- Arrest of disease process
- Prevention of disease or symptoms

Evidence-Based Medicine (EBM)


o The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the
individual patient. It means integrating individual clinical expertise with the best available external clinical
evidence from systematic research.

EBM integrated components


Clinical expertise  clinician’s cumulated experience, education and clinical skills
Patient values  personal and unique concerns, expectations, and values
Best evidence  clinically relevant research with sound methodology

Hierarchy of Evidence
Systematic reviews Phases of Product Development
Randomized Clinical Trials Pre-clinical Animal studies
Non-randomized Clinical Trials Phase 1 Healthy humans Safety
Observational Studies Phase 2 Patients with disease Effectiveness
Expert Options Phase 3 Large scale
Phase 4 Post-marketing surveillance
Drug Information Sources
Primary Most current information Journal articles
Secondary For quick and selective screening of 1° sources Abstracting and Indexing Services
Tertiary Easy access; may be outdated Textbooks

Study Designs
Case Control/ Cohort/ Cross-sectional/ Randomized
Retrospective Prospective Prevalence Studies Controlled Clinical Trial
Type Observational Observational Survey Experimental (gold st.)
Samples Presence (cases) or Presence or absence Disease prevalence Compares 2 or more
based on absence (controls) of risk factors and prevalence factors tx or tx and placebo
of a disease (monitor for disease
development)
Advantage Inexpensive Less recall bias Decreased bias and
confounding
Blinded or Double
blinded
D/A Recall bias Time-consuming, Costly and time-
expensive intensive, ethical
considerations
Therapeutic Guidelines
o Provide clear and concise, independent and evidence-based recommendations about patient management that
have been developed by experts
o Objective: Reduce chance of error by establishing standard protocol for how care is carried out

Therapeutic Drug Monitoring


o Encompasses the measurement of serum drug levels and the application of clinical pharmacokinetics to improve
patient care

Applications
 Time to maximal response
 Need for loading dose
 Dosage alterations
 Choosing a formulation

Drugs requiring TDM


 Intensity of pharmacologic effect is proportional to the drug concentration at the site of action
 Drugs have an established therapeutic plasma range
 Relationship between plasma drug concentration & clinical effect rather than relation between dose & effect
 Drug toxicity and disease presentation are difficult to distinguish from clinical assessment alone

Therapeutic Range – the range of drug conc within which the drug exhibits max efficacy and min toxicity in px majority

Commonly Monitored Drugs:


 Aminoglycosides: gentamicin, tobramycin, netilmicin, amikacin, vancomycin
 Cardioselective agents: digoxin, procainamide, lidocaine, disopyramide, flecainide

Review of a Prescription
Drug-Related Problems
1. Medication Errors
Any preventable event that may lead to inappropriate medication use or cause harm to the patient while
the medication is in the control of a health care professional, patient or consumer

A Have the capacity to cause error

B Did not reach the patient

C Reached the patient

D Increased patient monitoring

E Treatment or intervention

F Initial or prolonged hospitalization

G Permanent harm

H Near-death

I Death

2. Adverse Drug Events


a. Patient Factors (ADRs, patient’s reaction to drug)
b. Drug Factors (D-D, D-F, D-Dis interactions, other incompatibilities)

ADE - any injury resuling from medical intervention


ADR - response that is noxious or unintended

Pregnancy Categories
Category Human Studies Animal Studies Effect Examples
A ✓ ✓ SAFE
B X ✓ SAFE Amoxicillin, Paracetamol

C X ✓ UNSAFE Rifampicin, Theophylline

D Benefits outweigh risks Phenytoin, Tetracycline

X ✓ ✓ TERATOGENIC Isotretinoin, Thalidomide


Patient Case
General Patient Information Date and time of admission, patient name, age, race, gender
Chief Complaint Reason for seeking medical care
HPI Narrative that described the current medical problem
PMH Current and previous problems unrelated to present illness
SH Use of tobacco & illicit drugs, occupation, marital status, sexual history, living condition
FH Medical histories of first degree relatives
Medication History Demography, diet, social habits, current and past Rx and non-Rx drugs, allergies, ADRs
ROS All patient complaints not included in the HPI
Physical Examination VS, systemic exam (HEENT, skin, ear, chest, abdomen, genitalia, neurologic)
Lab and Diagnostic Test
Px Problem List and Plans

Pharmaceutical Care Plan


1. Assessment - review of the medical conditions and symptoms to determine the need for drug therapy
2. Plan - decision of an appropriate drug therapy based on assessment
3. Monitoring - review of outcomes of therapy to determine if patient is obtaining desired outcomes

Drug Utilization Review (DUR)


o Ongoing study of the frequency of the use and cost of drugs
o Prospective DUR (before dispensing) or Retrospective DUR (after dispensing), Concurrent DUR (IDEAL)

Advantages:
 Identify drug-drug interaction
 Prevent duplication
 Prevent under/overdose
 Improve quality of care
 Encourage physicians to use formulary/generic drugs

Pharmacoeconomic Methodologies
Cost-Effectiveness Lowest cost for a given level of effectiveness
Cost-Minimization Comparison of drugs that are generically equivalent
Cost-Utility Incorporates a measure of QOL into outcomes being measured
Cost-Benefit Uses monetary value in comparing costs and consequences
Cost of Illness All direct and indirect cost attributable to a certain disease

Ethics
Autonomy Respect px as individual
Nonmaleficence Do no harm
Beneficence Act in the best interest of the patient
Confidentiality Respects px privacy and autonomy
Common Laboratory Tests
Hematologic
Test Increase Decrease

RBC/Erythrocytes Macrocytic Anemia


Polycythemia (B9 & B12)
Dehydration
Vomiting Microcytic Anemia
Hematocrit (IDA & thalassemia)

IDA
Hemolytic Anemia
Reticulocyte Aplastic Anemia
Blood loss
Bone Marrow Supp

Hemoglobin IDA, blood loss

Polycythemia
ESR Inflammation
Sickle cell anemia
Rheumatic Fever Infection
Corticosteroids

aPTT Heparin (Intrinsic) Hypercoagulation

PT Warfarin (Extrinsic 2, 7, 9, 10)

INR Warfarin

WBC Infection (leukocytosis) Marrow suppress (leukopenia)

Neutrophils Infection
Overwhelming infections
PMN’s Neutrophilic leukocytosis

Basophils/Mast Cells Chronic myelogenous leukemia

Acute allergic reactions


Eosinophils
Parasitic infections

TB
Monocytes
Subacute bacterial endocarditis

Lymphocytes Viral infections Immunodeficiency

Marrow suppression
Platelet Thrombocytopenia
Chemotherapy
Renal
Test Increase Decrease
BUN Renal failure Hepatic failure

Creatinine Renal failure ------------------

Creatinine clearance ------------------ Renal failure

Serum Enzymes
Test Increase Decrease
Creatinine Kinase (CK)
CK MB Myocardial Infarction
CK MM Rhabdomyolysis
CK BB
Lactate Dehydrogenase
Acute injury of cardiac muscles
LDH 1 and 2
Liver dysfunction Clofibrate and Fluoride
LDH 3
Lung disease, Hemolytic anemia
LDH 4 and 5

Biliary obstruction
Alkaline Phosphatase Paget’s disease
HyperPTH, Osteomalacia

Alanine Aminotransferase (ALT)


Liver disease B6 deficiency
Serum Glutamic-Pyruvic Transaminase (SGPT)

Aspartate Aminotransterase (AST) Myocardial Infarction


B6 deficiency
Serum Glutamic-Oxaloacetic Transaminase (SGOT) Liver disease

Cardiac Troponins Myocardial Infarction Rhabdomyolysis

Electrolytes
Test Increase Decrease

Hypertension
Sodium Hyponatremia (renal failure)
Hypernatremia (imp. excretion)

Renal dysfunction
Diuretic use, alkalosis, vomiting,
Potassium Acidosis
diarrhea, steroids, Amph B, Li
Cellular breakdown

Acute renal failure Chronic renal failure


Chloride Hyperparathyroidism Adrenal Insufficiency
Dehydration Diuretic use (Thiazide & Loop)
Minerals
Test Increase Decrease
Hyperparathyroidism
PTH or Vit. D deficiency
Calcium Paget’s disease
Loop diuretics
Thiazides
Hepatitis Malabsorption
Magnesium
Addison’s disease Hyperaldosteronism
Renal dysfunction, Malnutrition
Phosphate Hypoparathyroidism Hyperparathyroidism
Increased Vit. D intake Insufficient Vit. D intake

Others
Test Increase Decrease

Acid Phosphatase Prostate CA

Gamma glutamyl transpeptidase (GGT) Liver disease

Proteins
Albumin Liver disease
Globulin
Glucose
Normal
Diabetes Insulin, ethanol, propranolol,
DM (Fasting)
Corticosteroid use hypoglycemic
Hypoglycemia Male
Hypoglycemia Female

Glycosylated Hemoglobin (HbA1C) Uncontrolled DM Hemolytic anemia

Cholesterol
LDL
Atherosclerosis (LDL) Atherosclerosis (HDL)
HDL
Tryglycerides
Bilirubin Hemolysis
Direct Biliary obstruction
Indirect Liver necrosis
Gout Wilson’s disease
Uric acid
Rapid cellular destruction Malabsorption syndromes

Significance
Thyroid function test Establish level of thyroid function and response to suppressant or replacement therapy
Liver function test Designed to give information about the state of a patient's liver
Cardiac enzymes Used to diagnose Myocardial Infarction
Lipids Hyperlipidemia and risk assessment for CAD
Clotting time Used to prevent blood loss. Normal clotting time 2 – 6 minutes
CBC hgb, hct, RBC, WBC count, MCV, MCH, mean corpuscular hgb concentration
Stool exams, FOBT Diagnosis of certain conditions affecting the digestive tract
Urine exams Checks different components of urine, a waste product made by the kidneys
Sputum exams Bacteria or fungi that are infecting the lungs or breathing passages
Hospital Pharmacy
o Practice of pharmacy in a hospital
o Department wherein the procurement, storage, compounding, manufacturing, packaging, controlling,
assaying, dispensing, distribution and monitoring of medications take place
o Min: 6 beds
o CEO = hospital director

Primary - emergency
Secondary - no departments; level 1 + surgery; intermediate care
Tertiary - departmental; intense care
Quaternary - teaching & training; subspecialties

Long term HC facility - for recovering


Resident treatment facility - safe, hygienic, living arrangements for residents
Clinic/Infirmary - ambulatory
Ambulatory surgery
Birthing home

HOSPITAL FUNCTIONS

Patient Care
Education
Research
Public Health
HOSPITAL – organized structure which pools together all the health professionals, facilities, and supplies into a coordinated
system for delivering health care

Type of Service
 General
 Special

Length of Stay HOSPITAL PHARMACIST’S


 Short term <30 days RESPONSIBILITIES
 Long term ≥30 days
Policies and Procedure
Ownership Competence
 Governmental Training and Education
 Non-governmental Documentation
o Profit-oriented Interdisciplinary interaction
o Non-profit oriented

Bed Capacity
1. Under 50
2. 50-99
3. 100-199
4. 200-299
5. 300-399
6. 400-499
7. 500 and over

SUPPORTING SERVICES
1. Nursing
2. Dietary
3. Central Supply
4. Medical Record
5. Blood Bank
6. Pathology
7. Radiology
8. Anesthesia
9. Medical Social Service

MEDICAL STAFF/DOCTORS
Main types:
1. Open staff - Courtesy/on call
2. Closed staff - Exclusive/active/attending

Specific Types:
1. Honorary - retired
2. Consulting - specialists
3. Active/Attending - regular patient care (closed staff)
4. Associate - junior of active
5. Resident - specialized training
6. Courtesy - not affiliated; with privilege to admit
DIVISIONS
Plan, coordinate, supervise departmental activities
Develop policies
Administrative Services Make schedule of staff
Coordinate administrative needs of the P&TC

Coordinate activities of programs of pharmacy students


Education and Training Hospital-wide education program
Training

New formulations
Pharmaceutical Research Improve existing formulations
Cooperate in research

Provide medication for in-patients


In-Patient Services Inspection and Control
Cooperative with Research division

Compound and dispense out-patient Rx


Inspection/Control
Out Patient Services
Maintain Rx records
Provide DRUG CONSULTATION

Provide drug info on drugs and drug therapy to hospital staff


Drug Information Services Maintain drug information center
Hospital pharmacy newsletter, literature files

Control and Dispense IV Fluids


Departmental Services Control and Dispense Regulated Drugs
Coordinate and Control all drug delivery and distribution system

Maintain Drug Inventory


Purchase of Drugs
Purchase and Inventory Control Receive, store, and distribute drugs
Interview MedReps

Central Supply Services Coordinate the distribution of medical supplies and irrigating fluids

Perform Analyses
Assay and QC Develop and revise assay procedure
Assist in Research

Manufacture, Drug packaging


Manuf and Packaging Product Development
Unit dose program

Produce small volume parenterals


Sterile Products Manufacture sterile ophthalmic, irrigating solutions, etc
Perform Aseptic Dilution

Procurement, storage, and dispensing of radioisotopes


Radiopharmaceutical Services Involves proper handling and control

Centralize the preparation of IV admixture


IV Admixture Review each IV admixture for incompatibilities
Work with IV Therapy Nurses
PHARMACY AND THERAPEUTICS COMMITTEE
Objective: Achieve optimal patient care and safety through rational drug therapy
Primary Purposes:
1. Policy development
2. Education

Organization: Physicians (1 chairperson), Pharmacists (1 secretary), Nurses, Administrators, QA coordinators

Functions and Scope:


1. Evaluators and advisors for all matters pertaining to drug use
2. Develop formulary
3. Programs to ensure safe and effective drug therapy, and
4. Cost effective drug therapy
5. Educational programs on matters to drug use
6. QA activities related to distribution, admin, use of meds
7. Monitor and evaluate ADRs
8. Drug use evaluation programs and studies
9. Advice pharma department in implementing effective distribution and control
10. Disseminate information on its actions and approved recommendations to all HC staff

FORMULARY SYSTEM
o A method whereby the medical staff of an institution, working through the PTC, evaluates, appraises, and selects
from among the numerous available drug entities and drug products those that are considered useful in px care.

FORMULARY
o A continually revised compilation of pharmaceuticals reflecting the current clinical judgment of the medical staff

Part I. Information on Hospital Policies and Procedures Concerning Drugs


1. Drug categories
2. PTC description
3. Regulations (prescribing, dispensing, administering)
4. Operating procedures
5. How to use the formulary

Part II. Drug Product Listing


1. By generic name
2. Within therapeutic class
3. Combination

Minimum information:
 Generic
 Synonyms and brands
 DF, strengths, packagings, sizes stocked
 Formulation
 Additional information (adult and pedia dose, cautions, controlled substances symbol)

Part III. Special Information


1. List of Hospital-approved abbreviations
2. Rules in calculating pediatric doses
3. Dosing guides for renal impairment
4. Dialyzable poisons, etc.
PURCHASING AND INVENTORY CONTROL
𝒄𝒐𝒔𝒕 𝒐𝒇 𝒈𝒐𝒐𝒅 𝒔𝒐𝒍𝒅
𝑻𝒖𝒓𝒏𝒐𝒗𝒆𝒓 𝒓𝒂𝒕𝒆 =
𝒂𝒗𝒆𝒓𝒂𝒈𝒆 𝒐𝒇 𝒃𝒆𝒈𝒊𝒏𝒏𝒊𝒏𝒈 𝒂𝒏𝒅 𝒆𝒏𝒅𝒊𝒏𝒈 𝒊𝒏𝒗𝒆𝒏𝒕𝒐𝒓𝒚

Satisfactory turnover rate: 4 times a year


Low turnover  Sock duplication, Large purchases of slow moving items, Dead inventory
High turnover  Small volume purchasing

DISPENSING (In Patient)


1. Charge plate
2. Envelope System
3. Drug Basket Method
4. Mobile Dispensing Unit
5. Mechanical Dispensing

PRESCRIPTIONS

Violative Prescriptions
 generic name is not written;
 generic name is not legible, brand name is legible
 brand name is indicated and instructions added, such as 'No Substitution'

Impossible Prescriptions
 only generic name is written but illegible
 generic does not correspond with the brand
 both generic and brand are not legible
 product not registered with BFAD

Erroneous Prescriptions
 brand name precedes the generic name
 generic name is the one in parenthesis
 brand name is not in parenthesis
 more than one drug product is prescribed in one prescription form
Drug Utilization Review (DUR)
o Ongoing study of the frequency of the use and cost of drugs
o Prospective DUR (before dispensing) or Retrospective DUR (after dispensing), Concurrent DUR (IDEAL)

Advantages:
 Identify drug-drug interaction
 Prevent duplication
 Prevent under/overdose
 Improve quality of care
 Encourage physicians to use formulary/generic drugs

DRUG DISTRIBUTION SYSTEMS


Advantages Disadvantages
 Error
Floor Stock System  Readily available
 Inventory
Free Floor Stock  Transcription
 Pilferage
Charge Floor Stock  Personnel
 Deterioration hazards

 RPh reviews Rx
Individual Prescription Order (IPO)  Healthcare interaction  Delay
 Inventory control

Combination of I and II
- GOVERNMENT HOSPITALS
Unit Dose Dispensing (UDDDS)
 Time for direct px care
Centralized
 Eliminates potential ADE  Time-consuming
Decentralized
 Errors  Costly
Combined 1 & 2  Paper duplication
Partial

DRUGS FOR EMERGENCY BOX


Aminophylline Mannitol
Amphetamine Nalorphine HCl
Amylnitrite inhalation Neostigmine methylsulfate
Atropine sulfate Norepinephrine injection
Caffeine Na Benzoate Pentobarbital
Calcium gluconate Pentylenetetrazol injection
Chloroprophenpyrimadine maleate/Chlorphenamine Phenobarbital
Digoxin Phenylephrine
Diphenylhydantoin Na/Phenytoin Phytonadione injection
Epinephrine Picrotoxin injection
Heparin Procainamide
Hydrocortisone Protamine sulfate
Isoproterenol Saline for injection
Magnesium sulfate injection Sodium molar acetate solution
Metaraminol bitartate Water for injection
COMPOUNDING

IV FLUIDS
o for fluid replacement, electrolyte balance restoration and supplementary nutrition, and as vehicles for
administration of other drug substances and TPN
o LVP – 100-1000 ml
o SVP – 25-50 ml

IV ADMIXTURE
o When one or more sterile products are added to an IV fluid for administration
o Aseptic technique, laminar flowhood, air filtered through HEPA (High Efficiency Particulate Air)
o HEPA filters remove 99.97% of all particles larger than 0.3 um
 Horizontal or vertical flow
 Dioctylphthalate (DOP) test to determine proper functioning

TOTAL PARENTERAL NUTRITION/ Hyperalimentation


o IV administration of calories, N, and other nutrients to achieve tissue synthesis and anabolism
o Dudrick – technique via subclavian vein into superior vena cava
o For patients unable to digest, refuse to eat, cannot be fed orally
o Normal Caloric Requirement: 2500 calories/day for adults

Formulation of TPN:
1. Protein
2. Carbohydrates
3. Lipid
4. Electrolytes
5. Trace elements
6. Vitamins
7. Fluids

Container: Silicon based bags, superseded by PVC and ethylvinyl acetate


Storage and Packaging: 2-6°C, do not store at room temp in excess of 12-24 hours required for
administration. Polystyrene containers.
Pharmaceutical
Calculations
A. Metric System

Weight Volume

1 kilogram (kg) = 1,000 g 1 kiloliter (kL) = 1000 L


1 hektogram (hg) = 100 g 1 hektoliter (hL) = 100 L
1 dekagram (dag) = 10 g 1 dekaliter (daL) = 10 L
1 gram (g) = 1g 1 liter (L) = 1L
1 decigram (dg) = 0.1 g 1 deciliter (dL) = 0.1 L
1 centigram (cg) = 0.01 g 1 centiliter (cL) = 0.01 L
1 milligram (mg) = 0.001 g 1 milliliter (mL) = 0.001 L
1 microgram (µg) = 0.000001 g 1 microliter (µL) = 0.000001 L
1 nanogram (ng) = 0.000000001 g 1 nanoliter (nL) = 0.000000001 L

Length

1 kilometer (km) = 1000 m


1 hektometer (hm) = 100 m
1 dekameter (dam) = 10 m
1 meter (m) = 1m
1 decimeter (dm) = 0.1 m
1 centimeter (cm) = 0.01 m
1 millimeter (mm) = 0.001 m
1 micrometer (µm) = 0.000001 m
1 nanometer (nm) = 0.000000001 m

B. Common System: Apothecary and Avoirdupois Systems

Apothecary: Fluid Measures Apothecary: Weight Measures

1 fluidrachm (f ʓ) = 60 minims (ᶆ) 1 scruple (э) = 20 grains (gr)


1 fluidounce (foz) = 8 f ʓ = 480 ᶆ 1 drachm ( ʓ) = 3 scruples = 60 gr
1 pint (pt or O) = 16 foz 1 ounce (oz) = 8 drachms = 480 gr
1 quart (qt) = 2 pt = 32 foz 1 pound (lb) = 12 ounces = 5760 gr
1 gallon (gal or C) = 4 qt = 8 pt = 12 ounces = 373 g

Avoirdupois: Weight Measures Household Measures

1 ounce (oz) = 437.5 gr 1 teaspoonful = 5 mL = 1/6 f ʓ = 1 1/3 f


1 pound (lb) = 16 ounces 1 dessertspoonful = 10 mL
= 7000 grains 1 tablespoonful = 15 mL = ½ foz = 4fʓ
= 454 grams 1 glassful = 240 mL = 8 foz
CONVERSION
Volume Weights

1 mL = 16.23 minims (ᶆ) 1g = 15.432 gr


1ᶆ = 0.06 mL 1 kg = 2.2 lb (avoir.)
1 fʓ = 3.69 mL 1 gr = 0.065 g (65 mg)
1f = 29.57 mL 1 oz (avoir.) = 28.35 g
1 pt = 473 mL = 437.5 gr
1 gal (US) = 3785 mL 1 ʓ (apoth.) = 31.1 g
= 128 foz = 480 gr
1 f (water) = 455 gr 1 lb (avoir.) = 454 g
1 lb (apoth.) = 373.2 g

Length Approximate Equivalents

1 meter (m) = 39.37 in 1 tsp = 5 mL


1 inch (in) = 2.54 cm 1 tbsp = 15 mL
1 mL = 20 drops
Tumbler = 240 mL
Teacup = 120 mL
Wineglass = 60 mL

ROMAN NUMERALS Prefix Symbol Power of Ten


ss = ½ atto a 10-18
I or I = 1 femto f 10-15
V or v = 5 pico p 10-12
X or x = 10 nano n 10-9
L or l = 50 micro µ or mc 10-6
C or c = 100 milli m 10-3
D or d = 500 centi c 10-2
M or m = 1000 deci d 10-1
deka ds 101
hecto h 102
kilo k 103
mega M 106
giga G 109
tera T 1012
peta P 1015
exa E 1018
FORMULAS TO REMEMBER
PERCENTAGE ERROR

𝐸𝑟𝑟𝑜𝑟/𝑆𝑒𝑛𝑠𝑖𝑡𝑖𝑣𝑖𝑡𝑦
% 𝐸𝑟𝑟𝑜𝑟 = 𝑄𝑢𝑎𝑛𝑡𝑖𝑡𝑦 𝐷𝑒𝑠𝑖𝑟𝑒𝑑
𝑥 100%

𝑚𝑎𝑥 𝑝𝑜𝑡𝑒𝑛𝑡𝑖𝑎𝑙 𝑒𝑟𝑟𝑜𝑟 𝑜𝑟 𝑠𝑒𝑛𝑠𝑖𝑡𝑖𝑣𝑖𝑡𝑦


𝑆𝑚𝑎𝑙𝑙𝑒𝑠𝑡 𝑄𝑢𝑎𝑛𝑡𝑖𝑡𝑦 = 𝑥 100
𝑃𝑒𝑟𝑚𝑖𝑠𝑠𝑖𝑏𝑙𝑒 𝑒𝑟𝑟𝑜𝑟

CALCULATION OF DOSES/POSOLOGY

Children | Based on Body Weight

𝑨𝒈𝒆
Young's Rule, based on age × 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝑨𝒈𝒆 + 𝟏𝟐

𝑨𝒈𝒆 𝒂𝒕 𝒏𝒆𝒙𝒕 𝒃𝒊𝒓𝒕𝒉𝒅𝒂𝒚 (𝒚𝒆𝒂𝒓𝒔)


Cowling's Rule × 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝟐𝟒

𝒎𝒐𝒏𝒕𝒉𝒔
Fried's Rule for Infants × 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝟏𝟓𝟎

𝒍𝒃𝒔
Clark's Rule × 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝟏𝟓𝟎

Children | Based on Body Surface Area

𝑩𝑺𝑨 (𝒎𝟐 )
𝑥 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝟏. 𝟕𝟑 𝒎𝟐

𝐵𝑆𝐴 𝑜𝑓 𝑐𝑕𝑖𝑙𝑑 (𝑚2 ) 𝑥 𝐷𝑜𝑠𝑒 𝑝𝑒𝑟 𝑚2

ADULT DOSE

𝑩𝑺𝑨 (𝒎𝟐 )
𝑥 𝑈𝑠𝑢𝑎𝑙 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝟏. 𝟕𝟑 𝒎𝟐

𝑖𝑛 × 𝑙𝑏 𝑐𝑚 × 𝑘𝑔
𝐵𝑆𝐴 = √ 𝐵𝑆𝐴 = √
3131 3600
DENSITY, SPECIFIC GRAVITY AND SPECIFIC VOLUME

𝒎𝒂𝒔𝒔 (𝒈)
Density
𝒗𝒐𝒍𝒖𝒎𝒆 (𝑳)

𝒘𝒕𝒔𝒖𝒃𝒔
Specific Gravity (same volumes)
𝒘𝒕𝒔𝒕𝒅

𝑽𝒔𝒕𝒅
Specific Volume (same volumes)
𝑽𝒔𝒖𝒃𝒔

DILUTION AND CONCENTRATION


𝑪 𝟏 𝑽𝟏 = 𝑪 𝟐 𝑽𝟐

Alligation Medial – “weighted average” | % strength ng whole solution pag hinalo ang solutions na iba-ibang %

Alligation Alternate – number of parts ng each component mag hinalo to achieve a desired strength

ISOTONIC SOLUTIONS
𝑀𝑊 𝑜𝑓 𝑁𝑎𝐶𝑙 (58.5) 𝑖 𝑓𝑎𝑐𝑡𝑜𝑟 𝑜𝑓 𝑡ℎ𝑒 𝑠𝑢𝑏𝑠
𝑁𝑎𝐶𝑙 𝑒𝑞𝑢𝑖𝑣 = ×
𝑖 𝑓𝑎𝑐𝑡𝑜𝑟 𝑜𝑓 𝑁𝑎𝐶𝑙 (1.8) 𝑀𝑊 𝑜𝑓 𝑠𝑢𝑏𝑠

1. Ilan ang meron (equivalent).


2. Ilan ang dapat meron (NaCl).
3. Ilan ang idagdag para maabot ang dapat meron (subtraction).
4. Optional. Divide

PROOF STRENGTH
Proof spirit – an aqueous solution containing 50% (v/v) of absolute alcohol
Proof strength of alcohol – expressed by taking 50% alcohol, or proof spirit, as 100 proof
Proof gallon – frequently used to measure, or evaluate, alcohols of given quantities and strengths

Proof Strength % ×𝟐

𝑾𝑮 𝒙 % 𝑾𝑮 𝒙 𝑷𝒓𝒐𝒐𝒇
Proof Gallons
𝟓𝟎 𝟏𝟎𝟎
𝒈𝒔𝒐𝒍𝒖𝒕𝒆
Molarity (M) 𝑴𝑾 × 𝑳𝒔𝒐𝒍′𝒏

𝒈𝒔𝒐𝒍𝒖𝒕𝒆
Normality (N) 𝑴𝑾
× 𝑳𝒔𝒐𝒍′𝒏
𝒇

𝒈𝒔𝒐𝒍𝒖𝒕𝒆
Molality 𝑴𝑾 × 𝒌𝒈𝒔𝒐𝒍𝒗𝒆𝒏𝒕

𝒘𝒕(𝒎𝒈) 𝑭 𝑴𝑾
Milliequivalent (mEq)
𝑴𝑾 𝑭 × 𝟏𝟎𝟎𝟎

𝒈
Moles (m) 𝑴𝑾

𝒎𝒈
Millimoles (mmol) 𝑴𝑾

𝒘𝒕(𝒎𝒈) 𝑭
mOsmol
𝑴𝑾

𝑎𝑚𝑡 𝑜𝑓 𝑓𝑙𝑢𝑖𝑑 𝑥 𝑔𝑡𝑡𝑠/𝑚𝐿 (𝐼𝑉 𝑠𝑒𝑡)


RATE OF INFUSION 𝑔𝑡𝑡/𝑚𝑖𝑛 =
𝑕𝑟𝑠 𝑡𝑜 𝑎𝑑𝑚𝑖𝑛𝑖𝑠𝑡𝑒𝑟 𝑥 𝑚𝑖𝑛𝑠/𝑕𝑟

𝑘𝑔 𝑙𝑏𝑠 × 704.5
BMI
𝑚2 𝑖𝑛

(𝟏𝟒𝟎 − 𝐴𝑔𝑒)(𝑘𝑔)
Cockroft and Gault 𝐶𝑟𝐶𝑙𝑴 = 𝐶𝑟𝐶𝑙𝑭 = 𝐶𝑟𝐶𝑙𝑀 × 𝟎. 𝟖𝟓
𝟕𝟐 (𝑆𝐶𝑟 𝑖𝑛 𝑚𝑔/𝑑𝐿 )

𝟗𝟖 − [(𝟎. 𝟖)(𝐴𝑔𝑒 𝑖𝑛 𝑦𝑒𝑎𝑟𝑠 − 𝟐𝟎)


Jeliffe Equation 𝐶𝑟𝐶𝑙𝑴 = 𝐶𝑟𝐶𝑙𝑭 = 𝐶𝑟𝐶𝑙𝑀 × 𝟎. 𝟗𝟎
𝑆𝐶𝑟 𝑖𝑛 𝑚𝑔/𝑑𝐿 )